Provider Demographics
NPI:1831842426
Name:HAMMAD, LINA
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:HAMMAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9357 GLOXINIA WAY
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-6666
Mailing Address - Country:US
Mailing Address - Phone:571-991-6205
Mailing Address - Fax:
Practice Address - Street 1:9357 GLOXINIA WAY
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-6666
Practice Address - Country:US
Practice Address - Phone:571-991-6205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA94185104Medicaid